Any way to correct orbital bone related eye hollows? (photos)

Dear SophiaZThank you for your question!  The contour change can be done with Restylane in the office or with micro fat grafting in the operating room.  Both give excellent results - the fat grafting is permanent and the Restylane will last 1 to 2 Years.With Warm Regards,Trevor M Born MD

Forget the surgical blepharoplasty with its attendant expense and downtime. You should do extremely well with simple nonsurgical augmentation of the midface and upper inner cheek regions using injectable volumizing fillers, such as Voluma XC, which I would choose for this purpose in my Upper East Side Manhattan office, and Stylage XXL that I would opt for in my Israel satellite office, where a far greater number of regulatory agency approved injectable fillers are available. This should go a long way to correcting the hollowness. For the tear troughs and incipient bags, I would choose Beletero Balance combined with a tiny amount of Radiesse. Belotero has little chance of giving rise to the unwanted bluish Tyndall Effect when injected superficially in the very delicate skin under the eyes, and Radiesse, a whitish colored material helps to lighten any darkness. Treatment by an experienced injector is crucial.

Hello,While fillers can sometimes be helpful to soften an irregularity, if you truly have a problem due to the shape of the bone, this can be smoothed out.  I do a procedure like this on average more than once every week.Excellent results can be achieved by an experienced surgeon.Good luck!

Hello,Your best options in that area are to consider something temporary like a filler, or to think of something longer lasting like fat grafting.Both need to be done by someone with a great deal of experience in that area. That said, the results can be quite remarkable when done right. 

The periocular area is very touchy because of the thin skin. Contour issues can often times be treated with filler.

It is important to avoid cookie cutter surgical approaches.  You have a very thin eyelid.  About 8 mm above the dark circle is a bump in the lower eyelid.  Put your finger on that bump.  What you are feeling is the orbital rim.  Transconjunctival blepharoplasty does nothing to change this.   At your age, I think you should avoid surgery and your best option is under eye filler with Restylane.  The challenge will be finding the right injector who can do a detailed filler service.  Take your time and find the right injector.  You need someone who really understands mid face anatomy and that will not be a technician at a spa.  Avoid permanent fillers including fat.  Best of luck in your search.  There is help out there.

Thank you for your pictures.  I assume you are talking about your lower eyelids? Your lower lids have characteristics of a tear-trough deformity.  This is related to a natural attachment of a ligament (i.e. the orbitomalar ligament) to the bones of the eye-socket.  It is fairly straightforward to release this ligament through a procedure known as a transconjunctival blepharoplasty.  In addition, I would usually graft a small amount of fat to this region which acts a permanent filler.  This is a very successful procedure which works very well.Best of luck!

I would proceed with caution.  You might consider Belotero hyaluronic acid filler for the tear trough area as it has less risk of causing the tyndall effect (blueness after filler placement), and can be reversed with an enzyme if you don't like the effect.  This is an area of filler placement requires a very skilled injector, and there have been reports of vision loss from facial fillers.  Conservative fat repositioning blepharoplasty from the inside (transconjunctival) of the eyelid is another option.

Dear Sophia,

It is a common human craniofacial
variant to have a large orbit and a relatively sunken socket. Within soft tissue over the lower aspect of
the orbital rim, the craniofacial orbital structures can become quite
apparent. Judging from your photo, you
do have what is commonly called a tear trough and an orbital-mallar groove or
grove that extends even from the lower aspect of the orbit onto the cheek. Although there are some surgical techniques
that are performed in the subperiosteal plane—either through the mouth or
through the temple or lower lid incision—one of the simplest approaches is the
use of soft tissue fillers.

Soft tissue fillers can be divided
into off-the-shelf, non-human products such as Restylane®, Juvederm® Refine or
even Bolatero. I perform infra-orbital
soft tissue restoration using a microcannula and I keep the plane of injection
under the orbicular soculae, just above the periosteum to minimize the risk of
any lumpiness or blue discolouration called the Tindall effect. This technique
can be quite an excellent solution for your aesthetic concern. The advantages of off-the-shelf, non-human
based products such as Restylane ® or
Juvederm® are that they are reversible.


If you’re not happy with the
aesthetic results, an enzyme can be injected that dissolves the product and
returns you to a normal aesthetic state.
For the past 20 years, I’ve performed brow, peri-orbital and face rejuvenation
surgical procedures. Quite often, lifts are combined with the restoration of
volume. In your case, you may not have
age-related volume loss, but instead hereditary exposure of the orbital bony
structures. The delicate and expert
placement of fat grafts, again in the under orbicularis or eye muscle plane is
also an excellent option. This could be
performed scarlessly with a small incision through the mouth or
transcutaneously. In expert hands,
orbital fat grafting could be an excellent long-term solution to your
concern. You live in a province and a
city where there are many excellent facial surgeons. Seek out a surgeon that has years of
experience performing aesthetic facial surgery and facial fat grafting, as the
consequences of fat grafting that you don’t like is that it is not as easily
removed or contoured or shaped in the post-operative phase as simple hyaluronic
acid sugar gels.

Hope this helps.

Sincerely,

R. Stephen Mulholland, M.D., Toronto
Certified Plastic Surgeon, Yorkville, Toronto